The Ultimate Guide to Sex and Disability (8 page)

What does this feeling make you want to do, think, or say? Do you want to have more of this feeling? Less? Feeling turned on might make you want to go out and talk to people, have sex with a partner, or stay home and touch yourself. It may make you happy, sad, angry, frustrated, or confused. These feelings are a crucial part of your sexual response.

Don't worry about whether your desires seem realistic to you. Trying to anticipate obstacles can get seriously unsexy, so for now just fantasize what you would like to do, and later you can decide how to deal with the barriers—or the opportunities!

Can You Distinguish Between Your Thoughts and Your Sensations?

Check out what's happening in your physical sensations and in your thoughts. Do feelings of being turned on lead you to fantasize about specific possibilities? Do your thoughts make you feel sexier? Or not sexy at all? Invariably sensation and thought interact and influence each other, but as with everything else, the goal is to learn more about what

precisely happens for you when you're turned on. Are there signs you can read in your body that show you are responding physically to the pleasure you are experiencing? Are there specific thoughts that trigger responses in your body? In the same way that people report effects of being turned on in their body (for example, feeling more relaxed, experiencing less pain), people also describe changes in their thoughts (fewer negative thoughts, even less anxiety).

How Do You Know When It's Over?

Since I became paralyzed in both legs I have noticed that I have varying kinds of orgasms, depending upon the situation. For example, when I play with myself and rub my clit a certain way my orgasms are much more intense. Sometimes my leg will go into spasm and my crotch feels tingly But when I am with my lover, I find that it is more difficult to have an orgasm even if he is doing everything right. I think it is because I rely on the sensation of my fingertips on my clit and lips and I am able to change how hard I press or how fast I rub based on how my clit feels on my fingertips. Sometimes, this is hard to explain to a lover because I am not always able to communicate clearly when I am feeling more sexually aroused. Eventually I do have an orgasm, and though they are satisfying, they are not as physically intense. I realize how it might be helpful for my lover to know what it is that I feel when I am masturbating so he knows what he may need to change or do differently.

In our view, too much is made of the finale of a sexual response. It's almost as if without a "proper" ending (which the experts always consider to be an orgasm) the experience somehow isn't valid. We think orgasms are great—for the bliss they provide as well as other benefits. Orgasms are a fine natural sleeping pill, and the least invasive form of pain management around. Many people who experience muscle spasms find the number of spasms reduced after orgasm. Yet all sorts of sex play can result in the pain reducing, spasm reducing, emotionally grounding effects people report from orgasms.

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We don't all experience orgasms as described in sex guides and erotic films. Many of us get off on sex play without reaching orgasm. You may even be experiencing an orgasm and not know it because you're too busy expecting it to feel like something else—either something you experienced before, or something you've heard so much about.

All of us have experienced a sense of alienation from our bodies and our sexual response. We all need to allow ourselves our sexual thoughts, sensations, and feelings with as few pressures as possible. For now we suggest that you give yourself permission to consider anything at all to be the proper end of a sexual experience. It may be occurring when you get tired, or bored, or cramp up, or have to go to work. Or it could be those fabulous multiple orgasms accompanied by gushing ejaculation. Just don't spend all your sexual energy worrying about how it will end.

Sexual Response Cycles

Masters and Johnson were two sex researchers who did pioneering work in the area of human sexuality by actually measuring the body responses of people having sex in a laboratory setting. From this research Masters and Johnson developed a model of sexual response in which they divided sexual response into four stages: excitement, plateau, orgasm, and resolution. To each of these stages Masters and Johnson assigned physiological responses, such as erection as a response to arousal.

Another researcher, Helen Singer Kaplan, changed their model somewhat by adding desire to the conception of sexual response, and suggested only three stages: desire, excitement, and orgasm.

We don't see these stages as particularly useful. If you're one of those people who really gets off on research and science, check out any of the books in the Sexuality: Disability-Specific Resources section of chapter 14 for more detailed information. We do think that over time you will come to recognize your own sexual response: the signals your body gives you that it wants more of one thing and less of something else.

Arousal

Researchers have found certain common physical effects of getting turned on; these include faster heart rate, heightened muscle tension, increased blood flow, greater body warmth, the production of lubrication, swelling of the clitoris and vaginal lips in women's bodies, penile erections in men's bodies, nipple erections in both men and women, as well as increased sensitivity to stimulation and reduced sensitivity to pain.

Lubrication in women and erections in men can be stimulated in either (or both) of two ways. Our thoughts or memories can send a signal through the spinal cord to the genitalia, causing these signs of arousal. The other way is a reflex—a cycle of nerve stimulation that originates lower than the brain. Many men wake up in the morning with an erection, called a reflex erection. The signals for these come from the lower (sacral) area of the spinal cord. A person who has no sensation in their genital area still has nerves there that are connected to the spinal cord, so they can still have these signs of arousal. Genital stimulation can cause reflex lubrication or erection even when the person isn't aroused, and even if they don't want to have sex.

We recommend you try to pay attention to what it's like to get turned on both in your body and thoughts without putting physiological labels on the experience.

Erections

Getting an erection is something that both men and women may experience. As we said in the anatomy section, a number of body parts have erectile tissue in them—tissues that fill up with blood that is then trapped, making the area swell and become firm. This happens most obviously in the penis, but also in the clitoris, nipples, and earlobes. Erections carry an enormous social and personal meaning, particularly in men. Getting and keeping hard-ons, and having an orgasm through ejaculation, are a potent (pun intended) symbol of masculinity. A man might have difficulty, or be unable to get or maintain an erection because of reduced blood supply, changes in nerve stimulation, depression, or medications.

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Ejaculation

For most men ejaculation and orgasm are synonymous, even though they are two distinct processes and experiences. This is better illustrated when we talk about women ejaculating. Despite some remaining controversy among researchers, most people who work in the area of sexual health education acknowledge that women have the capacity to ejaculate. (See our section earlier in this chapter on the G-spot.) While many women who ejaculate find it pleasurable, we would hate to see it become something else that people feel they must achieve sexually. There is already enough pressure around sex.

For women who live with incontinence, ejaculation (which often results from stimulation of the C-spot) may cause some distress. When women ejaculate, it looks, feels, and sometimes even smells a little like urine. But it's not. In fact, even if you live with incontinence, at times you may think you've peed, when in fact you ejaculated. Fear of being incontinent during sex keeps many people away from sex, while others have sex but get so preoccupied with worry about incontinence that pleasure is the furthest thing from their minds. Many manage to work through their initial fear (usually with a few peeing moments along the way) and discover that it is not the end of the world and does not have to "destroy the moment." We do what we can to lessen the chance of peeing during sex (such as not drinking coffee or tea or alcohol when we are planning or hoping to have sex, not drinking anything in the hour before, and peeing right before we have sex). None of these things will, however, prevent ejaculation. If we have only negative associations about fluid involuntarily coming out of our bodies, it may be hard to experience what some women call the "joy of squirting." On the other hand, knowing that ejaculation is possible gives an opportunity to think in a whole new way about getting all wet during sex. If there is the possibility of shooting some fluid during sex (whether pee or ejaculation), it's happening because we were in the throes of pleasure—which is surely a good thing. We're not trying to be glib about incontinence issues, but do want to point out how discovering parts of our sexuality that we're not usually told about can give us the chance to change the way we think

about things. This is especially important when our thinking is so guided by nondisabled cultural norms.

Men are often unaware that they can have orgasms without ejaculating (and can ejaculate without orgasm), because these two things usually happen so close together as to be indistinguishable. Some men experience a type of orgasm called dry orgasm or retrograde ejaculation. When this happens a man will experience an orgasm but no ejaculate will come out. Usually this is because the ejaculate is emptied backward and flows into the bladder. This condition is not dangerous. Most men with dry orgasm claim that the sensation during orgasm is unchanged. In chapter 10 on Tantric sex we will share with you some exercises on learning to distinguish these two processes and to achieve orgasm without ejaculation. One thing that appears to be a biological reality is that after ejaculating there is a short period of time when ejaculating again is impossible. There is no evidence to suggest that continuing to experience sexual pleasure and even orgasm is impossible following ejaculation. Again, ejaculation is just one of many things that happen during sex—and part of finding a sexuality that feels right is choosing what to do, in what order, and when.

Orgasm

Orgasms come in all different shapes, sizes, colors, and textures. In our survey, people used all sorts of words to describe orgasms—everything from "wonderful" and "releasing," to "spiritual" and "mind-altering," to "painful" and "confusing." Orgasm is such a subjective experience that when we start to define it, it can seem as if there's a right way and wrong way to have one. There isn't.

You may never have had an orgasm and would like to experience them. People have told us that their doctor said they would never experience an orgasm, only to have one (or many) later in their lives. So it is possible.

Mitch Tepper, the founder of sexualhealth.com and a sexuality educator and researcher, has written extensively about orgasm. He

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writes both as a professional and a man living with a spinal cord injury. In reviewing the research on spinal cord injury (SCI), Tepper writes:

About half of spinal cord injury survivors can experience orgasm and this ability is not strongly related to the level or completeness of injury. Some of us, for that matter, find sex even better than before injury. There is growing evidence that sexual knowledge, sexual self-esteem, and time since injury are related to the ability to experience sexual pleasure and orgasm. It seems that knowledge is power, power fuels self-esteem, and self-esteem opens the door to sexual pleasure. Orgasmic sex requires tuning in to our sensations—in the moment—and forgetting about quad bellies, atrophy, catheters, and making embarrassing sounds. It means not worrying about performing up to some imagined standard. And it means forgetting what we learned in the past about what is and isn't pleasurable.

The basic process of orgasm starts with a buildup of excitement through sexual interest and arousal. The body goes through changes, including increased heart rate, blood pressure, body temperature, and muscle tone, as well as physical changes like the testicles increasing in size and the vagina expanding. With orgasm comes a release that is associated with muscular contractions. Immediately following an orgasm we all have a period (called a refractory period) when we will not experience another orgasm. For some people this period is short, perhaps only minutes long, while for others it can be hours.

Multiple orgasms are a series of orgasms one after another. Reports suggest that women have a much shorter refractory period and, if they continue to receive stimulation, can experience more than one orgasm in a row. More recently it has been suggested that men too can experience multiple orgasms by learning to have nonejaculatory orgasms. Some women seem to roll from orgasm to orgasm quite rapidly.

How Do You Define Orgasm, Anyway?

It's important to remember that orgasm has been defined by nondisabled people observing the sexual behavior of other nondisabled people. So

we can't expect to see much of our experience in the literature (whether it's a self-help book or a medical journal). People have chosen to distinguish orgasms in different ways.

Some people define orgasms based on what they feel like. Sex educator and author Betty Dodson distinguishes what she calls "tension orgasms," which are the result of tensing your body up during arousal and climax, from "relaxation orgasms," which come from a longer and slower buildup of excitement and pleasure.

Another way to distinguish orgasms is based on where we feel them and how we get them. Some women report that orgasms from clitoral stimulation feel different than orgasms through penetration (it is worth noting that not many women have orgasms through penetration alone, although some research suggests that women with complete spinal cord injuries may be experiencing these orgasms for a reason; see below).